Healthcare Provider Details

I. General information

NPI: 1558082701
Provider Name (Legal Business Name): MARCI DANIELLE HEFFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 PARK DR
ABERDEEN NC
28315-1905
US

IV. Provider business mailing address

404 PARK DR
ABERDEEN NC
28315-1905
US

V. Phone/Fax

Practice location:
  • Phone: 912-755-6059
  • Fax:
Mailing address:
  • Phone: 912-755-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: